Limited Advantages of Intensity-Modulated Radiotherapy Over 3D Conformal Radiation Therapy in the Adjuvant Management of Gastric Cancer

Shlomo Alani, Viacheslav Soyfer, Natan Strauss, Dan Schifter, Benjamin W. Corn*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Although chemoradiotherapy was considered the standard adjuvant treatment for gastric cancer, a recent Phase III trial (Medical Research Council Adjuvant Gastric Infusional Chemotherapy [MAGIC]) did not include radiotherapy in the randomization scheme because it was considered expendable. Given radiotherapy's potential, efforts needed to be made to optimize its use for treating gastric cancer. We assessed whether intensity-modulated radiotherapy (IMRT) could improve upon our published results in patients treated with three-dimensional (3D) conformal therapy. Methods and Materials: Fourteen patients with adenocarcinoma of the stomach were treated with adjuvant chemoradiotherapy using a noncoplanar four-field arrangement. Subsequently, a nine-field IMRT plan was designed using a CMS Xio IMRT version 4.3.3 module. Two IMRT beam arrangements were evaluated: beam arrangement 1 consisted of gantry angles of 0°, 53°, 107°, 158°, 204°, 255°, and 306°. Beam arrangement 2 consisted of gantry angles of 30°, 90°, 315°, and 345°; a gantry angle of 320°/couch, 30°; and a gantry angle of 35°/couch, 312°. Both the target volume coverage and the dose deposition in adjacent critical organs were assessed in the plans. Dose-volume histograms were generated for the clinical target volume, kidneys, spine, and liver. Results: Comparison of the clinical target volumes revealed satisfactory coverage by the 95% isodose envelope using either IMRT or 3D conformal therapy. However, IMRT was only marginally better than 3D conformal therapy at protecting the spine and kidneys from radiation. Conclusions: IMRT confers only a marginal benefit in the adjuvant treatment of gastric cancer and should be used only in the small subset of patients with risk factors for kidney disease or those with a preexisting nephropathy.

Original languageEnglish
Pages (from-to)562-566
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number2
StatePublished - 1 Jun 2009
Externally publishedYes


  • Conformal irradiation
  • Gastric cancer
  • intensity-modulated radiotherapy (IMRT)


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